Firefighter Paramedic/Firefighter AEMT

Position of Interest

Position Applying For (required)

Date of Application (required)

Employment Desired (required)

Full-Time

Part-Time

Intern

Date Available to Start (required)

Resume (required)

Personal Information

Name (required)

Phone Number (required)

Email (required)

Street Address (required)

City (required)

State (required)

Zip Code (required)

Driver's License Number (required)

State Issued (required)

Expiration Date (required)

Have you ever been convicted of a felony? (required)

Yes

If yes, please explain

Have you previously been employed by North Davis Fire District? (required)

Yes

If yes, when?

Do you have any relatives employed by North Davis Fire District? (required)

Yes

If yes, please list their names.

Are you legally eligible for employment in this country? (required)

Yes

If so, do you possess a work permit? (required)

Yes

Some positions have age requirements. Are you 18 years or older? (required)

Yes

Are you currently employed? (required)

Yes

If so, may we contact your present employer?

Yes

Special Skills or Certificates

Do you have Fire 1? (required)

Do you have Fire 2? (required)

What is your medical certificaton level? (EMT-B, AEMT, Paramedic) (required)

Please list any other skills, certificates, or licenses which you possess. (required)

Please upload a copy of your certifications (required)

Please upload a copy of your certifications

Education

High School (required)

Address (required)

College

Address

Degree?

Yes

If so, what degree?

Other

Address

Degree/Certification?

Yes

If so, what?

Employment History

Company

Position

Address

Employment dates

Supervisor name

Phone number

Reason for leaving

Responsibilities

May we contact your previous supervisor/employer for reference?

Yes

Company

Position

Address

Employment dates

Supervisor name

Phone number

Reason for leaving

Responsibilities

May we contact your previous employer/supervisor for a reference?

Yes

Company

Position

Address

Employment dates

Supervisor name

Phone number

Reason for leaving

Responsibilities

May we contact your previous supervisor/employer for a reference?

Yes

References

Full name

Relationship

Company

Phone number

May we contact this reference?

Yes

Full name

Relationship

Company

Phone number

May we contact this reference?

Yes

Full name

Relationship

Company

Phone number

May we contact this reference?

Yes

Disclaimer and Signature

I certify that the information contained in this application is correct to the best of my knowledge, and I understand that falsification of this information or information given in an interview is grounds for refusal to hire or if hired, dismissal. I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise with regard to any of the subjects covered by this application and release all such parties from all liability for any damage that may result from furnishing such information to you. I authorize you to request and receive such information. I understand that this application will remain active only for the time period in which the position I applied for remains open. I authorize investigation of all statements contained in this application and an investigation of my background, including any and all criminal history records and driver’s license history. I understand that the findings of the investigation may or may not may or may not bar me from employment with the North Davis Fire District. (Please type your name) (required)

Date (required)

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